The prognostic value of troponin T and N-terminal pro B-type natriuretic peptide, alone and in combination, in heart failure patients with and without diabetes
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AIMS: We examined the prognostic importance of N-terminal pro B-type natriuretic peptide (NT-proBNP) and troponin T (TnT) in heart failure patients with and without diabetes.
METHODS AND RESULTS: We measured NT-proBNP and TnT in the biomarker substudy of the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure trial (PARADIGM-HF). Of 1907 patients, 759 (40%) had diabetes. Median TnT in patients with diabetes was 18 (interquartile range 11-27) ng/L and 13 (9-21) ng/L in those without (P < 0.001). The TnT frequency-distribution curve was shifted to the right in patients with diabetes, compared to those without diabetes. By contrast, NT-proBNP did not differ between patients with and without diabetes. Diabetes and each biomarker were predictive of worse outcomes. Thus, patients with diabetes, an elevated TnT and a NT-proBNP level in the highest tertile (9% of all patients) had an absolute risk of cardiovascular death or heart failure hospitalization of 265 per 1000 person-years, compared to a rate of 42 per 1000 person-years in those without diabetes, a TnT < 18 ng/L and a NT-proBNP in the lowest tertile (16% of all patients). TnT remained an independent predictor of adverse outcomes in multivariable analyses including NT-proBNP.
CONCLUSION: TnT is elevated to a greater extent in heart failure patients with diabetes compared to those without (whereas NT-proBNP is not). TnT and NT-proBNP are additive in predicting risk and when combined help identify diabetes patients at extremely high absolute risk.
Original language | English |
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Journal | European Journal of Heart Failure |
Volume | 21 |
Issue number | 1 |
Pages (from-to) | 40-49 |
Number of pages | 10 |
ISSN | 1388-9842 |
DOIs | |
Publication status | Published - Jan 2019 |
- Aged, Biomarkers/blood, Diabetes Mellitus, Type 2/blood, Europe/epidemiology, Female, Heart Failure/blood, Humans, Male, Morbidity/trends, Natriuretic Peptide, Brain/blood, Peptide Fragments/blood, Prognosis, Prospective Studies, Risk Factors, Stroke Volume/physiology, Survival Rate/trends, Troponin T/blood
Research areas
Links
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607514/pdf/EJHF-21-40.pdf
Final published version
ID: 234274513